Friday, 30 March 2012

I would like to post more frequent updates; but unfortunately I have been somewhat time-poor lately. Quite often, I have a running commentary in my head of things that I would like to write about or reflect on here if I had a computer open in front of me. Unfortunately these occur at times too inconvenient and too often for me to act upon. Regardless, no time like the present for a quick catch-up.

I completed a mid-term assessment with my mentor a few weeks ago and to my relief, I was assured that I am doing okay. I was worried that I would be flagged for being too slow or not seeing enough patients, but nothing of the sort was mentioned. I remember on my first shift ever I managed to see only 2 patients(!). Now I'm seeing about 6-7 patients, depending on the area of the ED that I'm working in. I hate to be so fixated on numbers when, at the end of the day it's people we're treating; but it seems like a reasonable way to guage progress and efficiency.

Fastforward to the present. I am a mere 2 days away from completing my rotation in the ED! Incredible, how quickly time passes when you're so busy and focused. More incredible still, is that fact I have actually survived my first rotation ever as an intern (and from what I gather, one of the more challenging ones too)! Cliched as it may sound, the learning curve has been steep and I feel like I have learnt so much in such a short period of time. Of course it is only in hindsight that you realise how valuable the experience has been.

Admittedly, a part of me is actually going to miss being part of the ED team. By the same token, I am glad that it will be a while before I encounter people who annoyingly present to the hospital (sometimes via ambulance) without a valid medical complaint. The "Acopics" - as I have come to call them - are a unique breed of time- and resources-wasters who, for whatever reason, feel that a trip to the ED will fix all their problems. Some examples of shameless presentation that I have encountered include:
- burping after eating some sausages
- requesting a shower because the water in their apartment was too cold
- blocked nose for 20 years
- requesting a chat to overcome loneliness
... and so on. Clearly some people have too much time on their hands.

My next rotation is called "Relief". It basically involves covering or relieving people who are away from their normal rotations; taking your own annual leave; and providing cover for the wards after hours and overnight. My timetable looks a bit like this:

Week 1: cover in the ED (ok, so back sooner than I would like, but I'll just be an extra over the Easter long weekend)Week 2: renal medicineWeeks 3-6: annual leave (yay! going away for the entire 4 weeks to visit family in Jordan)Weeks 7-11: rotating roster of 7 nights on/ 7 off as the overnight medical intern providing cover to the medical wards - not sure what to expect here but I've heard that a rotation in ED should provide solid grounding in the basics of anything one might face

So, obviously the most exciting feature of this rotation is the ample opportunity for some rest, relaxation and travel, given the generous leave allowance. Going home to Jordan is always a welcome break to catch up with family, even if lacking in adventure and novelty; but I am going to try to also spend a few days in the Southern coastal town of Aqaba on the Red Sea for some scuba diving while I'm there, as well as the obligatory trip to the Dead Sea. We (my parents and I) have also been talking of going away to a neighbouring country like Syria or Turkey while we're in the region; plus on the way back we have planned a 4-day stopover in Dubai which could be fun (I have been a bit lazy with my research on what to do there because I'm not expecting to yield anything another than ritzy malls). The other time I will have off is the whole week after 7 nights on (of which I have 2 sets rostered - so essentially 2 lots of 1 week off) - long enough to go away again and I'm itching to just lie on a beach for a whole week and do nothing so I may actually make something of this time. I have been looking at destinations in the South Pacific, South East Asia and even within Australia but unfortunately the only places that have caught my attention are pricier that what I am allowing myself to spend on this mini-getaway. It's easy to get carried away with the thought that one day you may make a lot of money as a doctor; but presently I am only earning a humble $28.96 per hour, which is only marginally better what I was earning as an unqualified pharmacy assistant during my student days.

Anyway, enough yapping from me. Will hopefully call in again before I go overseas (and while I'm there) for some glorious travel tales.

Tuesday, 21 February 2012

It's Tuesday evening on my last day off after a run of evening shifts last week that included the weekend. This week I am back on night shifts starting from tomorrow night. This means that I must try to stay awake tonight and sleep for a good portion of tomorrow day so that I can stay awake tomorrow night, etc (you get the drift). Once this week is over, I will be half-way through my first internship rotation (yay!). Onwards and upwards people!

I wanted to post about how restless and unsettled I have been since returning from Fiji. Basically, for reasons I can't quite put my finger on, I just have this overwhelming desire to travel; and in particular, to be out at sea or settled on a little tropical island. It's crazy I know, but that's where I am right now. A few years back, before I had been anywhere (except for Jordan and here), I was desperate to just travel. This feels different though: less arbitrary and random... more focused. In short, I don't want to "just travel" anymore - I want to go to specific places, spend longer periods of time there, and (at the risk of sounding pretensious) somehow be involved or useful.

This time I risk sounding completely ungrateful - for the blessing of a stable income and the opportunity to further myself academically with this great internship program that I am undertaking - but the sad and inescapable truth is that it binds me here to quiet suburban Sydney life, for the next couple of years at least. Regardless, I am young, restless and hate nothing more than feeling powerless... so I map out plans instead. And this is not a bad time for it either. My last life plan ended last year with the completion of med school. I made a hasty one towards the end of the year (that of doing Anaesthetics training) to get me into the new year and starting internship with some degree of focus. Now it's time to go back to the drawing board.

"Why Anaesthetics?" was the first question I had to ask myself. Because it's scientifically interesting, well-paid, flexible and with a relatively low out-of-hours commitment load. These are all traits that make for a good speciality to practice in if you have plans for serious extra-curricular travel.

"Why not Anaesthetics then?" was the obvious second question to pose. The primary and fellowship exams are soul-destroying. I have had a look at the curriculum and at past papers. We're taking about an intimate, biochemical- and molecular-level-depth of understanding of human physiology and pharmacology here. It's important to know this stuff obviously - afterall, if you're going to be manipulating human physiology, you'd like to be well familiar on what you're dealing with. Here's the thing - every speciality has a set of exams that need to completed at some point in the training. Anaesthetics happens to be one of those specialities that has primary and exit exams. I would need to start studying for the primary exams in the next 6 months to stand any chance of passing. At the end of the day, it's been done before; but, personally, I don't think I have it in me to commit to rigorous study of such a dry nature anytime soon. At first, I was making other trivial excuses for wanting to switch to another speciality (like, wanting to leave the hospital system) but the bottom line is - as much as I would still love to actually do Anaesthetics, I just simply cannot commit to the academic requirements.

"So, now what?" Well, fortunately, in Australia, regardless of what medical training program one decides to do - that first year of training (this internship that I'm currently doing) is the same. So the door remains open for a little while yet, to decide on what happens next.

My objectives in life when I decided on Anaesthetics have changed somewhat. Back then, I was still set on the mode of wanting to "just travel". Inspired by my recent travels however, and with the added desire of wanting to be more purposeful and involved wherever I go; I've been considering medical specialities that allow for a broader spectrum in practice, geographically speaking. The founder of the Australian Royal Flying Doctor Service, Dr John Flynn, once asked, "What would it mean, if, wherever a little band of men advanced to try their fortune in the middle of nowhere, a Nursing Home, were it only of canvas, could be floated down among them?". This is a neat little clue as to where I'm heading. It makes perfect sense. I want to practice medicine, I want to travel, and I want to be purposeful in doing so - why not combine these? I live in a country with some of most beautiful and remote places on earth; a country that also happens to have a critical shortage of doctors in these areas. It really does make perfect sense! I'm not saying it's set in concrete or that it won't change (because I'm going through a crazy transition phase right now, so anything's possible) but I'm thinking about becoming... a Rural and Remote General Practitioner!

It would be an amazing journey just getting there, let alone pursuing it for life. Of course there are many challenges to be considered too - remoteness is not an element to be taken lightly and I will have to think long and hard about the social and family implications of this choice. But I need something to hold onto for now, or else my restless mind will continue to ruminate aimlessly.

I have spent the last few days browsing through the different regional training centres where I could undertake my training. I like the idea of moving to a tropical, coastal area so Tropical North Queensland and the Torres Strait Islands are high on my list. Like I said, lots to think about still, and much ground to cover.

So, what happens next? In April I will need to apply with the training college to register as a GP trainee. Then, later on in the year (not sure when exactly) I will have to select rotations for next year. The first year of training as a GP (after internship) has to be completed at a hospital-level; with compulsory rotations in Paediatrics, Obstetrics and Gynae, General Medicine, General Surgery, Anaesthetics and Emergency Medicine. After that, I can stay on in the hospital system for an extra year doing specific special-skills training (e.g. in Paediatrics, or O&G, etc) to gain some more experience in an area that would useful for someone who is going to practice in remote and rural settings. Or I can just start rural and remote GP training and return to a hospital setting to do the extra year of special-skills training at the end of the training. I'll describe the program in more detail later on because it's a bit confusing, but for now I'm quite happy that I have some direction in life!!

Inspiration, I am coming to learn, can come from all manner of sources around us. I leave you with a picture of one of the beautiful beaches I visited in Fiji. Seemingly a mere photo of a happy me on a pristine beach - lazy indulgence that is far from noble and far from heroeic. Why not post a picture instead of doctor helping out victims in a war zone or refugee camp? This picture means more than that. On that trip, we visited remote Fijian communities and I started to understand the value of a health care worker in these settings. Health care is so much more than about stepping up in the last minute and saving someone's life... I'll leave you to think about that for a bit.

Thursday, 9 February 2012

Thursday morning, 1:30 am. Just returned home from an evening shift. Too awake to go to sleep; to tired to do anything productive... so I reflect.

I've been meaning to post earlier but couldn't get in the right mood at any point before the present time. Week One of internship seems like it was forever ago and I specifically held off going on a blogging rampage under the influence of all the stress and emotion. Afterall, as with revenge, reflection is a dish best served cold. Week Two - the week just gone past - I was reduced to a zombie, working the graveyard night shifts, with little time/energy to do anything but go to work, fall into a deep coma between shifts, wake-up, and return to work on the evening of the same morning that I was just at work! This week I'm on evenings and the dust of novelty is settling; so it seems like a good a time as any other to reflect on the weeks that have been.

So, as I have alluded to, we work on a rotating roster - doing a run of Day (7.30am-6.00pm), Evening (2.00pm-12midnight) or Night (10.30pm-8.30am) shifts. Typically we will do about four of these shifts in a row, then have about three days off before rotating to a different time slot. While it has its advantages (like random days off midweek and the occasional long weekend), I can't say that I'm much a fan of shift work. There is a tendency to become so consumed in your own schedule that making social plans becomes too much of an effort, logistically. Night shift, in particular, is going to take me a while to adjust to. I always considered myself somewhat of a night owl - but I now appreciate the difference between staying up all night watching DVDs or reading a good book; and staying up all night with the expectation that actual work needs to be done and to the same standards/efficiency as if you were working during daylight hours. The fluoro lights help.. a bit.

The Emergency Department (or ED as we call it) at my hospital is a VERY busy place. I did my Emergency Medicine rotation in a small district hospital, with a low admission rate, frequented by the "worried well" who really should have presented to their GP/family doctor instead of coming to the ED. So my preparation for a term in a busy Tertiary Hospital ED was somewhat inadequate. It's growing on me and every shift is less overwhelming than the previous one was. There is a lot of support for the junior doctors of course, at all times, which I am very grateful for. The registrars, consultants, nurses... but mostly from each other. You end up being best buddies with your fellow intern who is on the same run of shifts with you for that week - like you survived war together, or something.

My buddy Daniel and I at about 4.30am on a night shift, trying to keep our spirits up

The work itself depends on where you're placed within the ED. I have only ever been assigned to the Acute Care area thus far, so I can't comment on other areas yet. Acute Care is where all the seriously ill patients are placed for review, assessment and initial management. Most of the patients in this area end up being admitted to the wards so there is a tendency to spend longer taking a thorough medical history, examining, investigating, and really getting to know these patients in anticipation of what will be required criteria by the admitting team in order for them to accept the patient. It's a bit bureaucratic - but you basically have to prove to another medical or surgical team that your patient in ED is sick or interesting enough for them to want to accept them under their care on the wards, because obviously the ED is not an endpoint in itself (despite how it's portrayed on ER!). This is the part that I have found most challenging. I have dealt with just about the entire spectrum of human personalities on trying to refer patients to other teams. Some teams are exceptionally open and inclusive - basically happy to take anyone whom the ED (at our discretion) think needs to be under their care. Other teams refuse to even talk to interns. So you have to be adaptable to whatever response awaits you at the other end of the telephone line. Thick skin and remembering that it's not personal also helps.. a lot. Enough said.

"So, what's the verdict doc?" I hear you asking.. Do I love it, do I hate it? Hmm.. hard to tell. Certainly, even as a distant memory, I wouldn't recall that first week as the happiest in my life. It's tough being the new kid in a new playground - that much I was sort of expecting. One morning I came home after a particularly harsh night shift and, despite being completely and utterly knackered, started frantically researching different medical specialty training programs that allowed for an early exit from the hospital system. I'm going to leave posting on that for a different day because this musing has gone on for long enough. I will admit though that switching to General Practice/Family Medicine was looking very attractive at one point. On the same account, three weeks in, things seem better than they did on Day One. The other thing, I work with doctors and nurses who have been there for years, decades even. That's something to hold onto for now.

Wednesday, 11 January 2012

I am less than a week away from starting internship so I thought it might be a good time to resume writing. The holidays have slipped away, as often happens, all too quickly :-( I have disposed of my medical school notes in a timely manner; cleaned my room (sort of); and finally unpacked my suitcase and stored it away after practically living out of it since I first packed it for my rural placement in Lithgow in September (!).

There's a sense of change in the air - all too familiar, I've been here before. I'm still adjusting to life as a non-student. It's weird and I don't know what to do when I am at home. What do people do in their free time? I want to take up photography as a hobby and have been meaning to enrol in a community college course. It's only one class a week over eight weeks but you have to attend a set day and owing to the shift-work nature of my first couple of rotations, I will have to put it on hold until my third internship rotation where I will finally (hopefully) have a more predictable working roster. Speaking of rotations, I got very lucky in my allocation and will be doing the following rotations over the course of the year:

1. Emergency medicine
2. Relief/night cover/annual leave (where you cover for other people who are away on their normal rotations; do night-shift cover for the hospital and take annual leave)
3. Cardiology
4. Vascular surgery
5. Emergency medicine (at a different hospital)

I'm a bit freaked out about starting in Emergency Department because, unlike ward duty where you mostly just follow orders made by more senior members of the treating team, in the ED you actually have to make your own decisions. Do I order this test? Do I prescribe this drug? Do I discharge the patient home or admit them? We are supposed to present each patient to a senior supervisor at some point in our clinical work-up; but I don't know how much of that actually happens in reality and I'm actually quite nervous about being assigned a supervisor who will just tell me to pick up my slack and start making my own clinical judgements!! Okay, clearly I have been watching too many episodes or ER :-S Just to be sure I don't get into a pickle, I have ordered a copy of The Oxford Handbook of Emergency Medicine as a safety net in case I run out of ideas on what to do next with a given patient and can't find anyone to help me. There you have it people: seven years of university and I will be flipping frantically through a how-to guide before I do anything. Warning: do not become ill for the first few months of the year as there is a good chance that you will be looked after by a clueless intern if you present to the ED. Don't say I didn't warn you. Maybe they will just assign me all the triage category 4 and 5 patients who really should have gone to their GPs instead and I will be stuck all day writing sick notes for sore throats and blocked noses.

Anyway, I don't care what I'm presented with. I have gone into survival mode and I have one aim for this year and that is: to make it out alive.

Blog Archive

About Me

I have just finished medical school and have started my internship this year. I'm clueless, even on a good day - but we all have to start somewhere I guess. I hope through these musings to share some of my experiences; to reflect some ideas and on the odd occasion, just to downright debrief.